Propofol-Based Procedural Sedation with or without Low-Dose Ketamine in Children

Objective Examine comparative dosing, efficacy, and safety of propofol alone or with an initial, subdissociative dose of ketamine approach for deep sedation. Background Propofol is a sedative-hypnotic agent used increasingly in children for deep sedation. As a nonanalgesic agent, use in procedures (e.g., bone marrow biopsies/aspirations, renal biopsies) is debated. Our intensivist procedural sedation team sedates using one of two protocols: propofol-only (P-O) approach or age-adjusted dose of 0.25 or 0.5 mg/kg intravenous ketamine (K + P) prior to propofol. With either approach, an initial induction dose of 1 mg/kg propofol is recommended and then intermittent dosing throughout the procedure to achieve adequate sedation to safely and effectively perform the procedure. Approach: Retrospective evaluation of 754 patients receiving either the P-O or K + P approach to sedation. Results A total of 372 P-O group patients and 382 K + P group. Mean age (7.3 ± 5.5 years for P-O; 7.3 ± 5.4 years for K + P) and weight (30.09 ± 23.18 kg for P-O; 30.14 ± 24.45 kg for K + P) were similar in both groups (p = NS). All patients successfully completed procedures with a 16% combined incidence of hypoxia (SPO2 < 90%). Procedure time was 3 minutes longer for K + P group than P-O group (18.68 ± 15.13 minutes for K + P; 15.11 ± 12.77 minutes for P-O; p < 0.01), yet recovery times were 5 minutes shorter (17.04 ± 9.36 minutes for K + P; 22.17 ± 12.84 minutes for P-O; p < 0.01). Mean total dose of propofol was significantly greater in P-O than in K + P group (0.28 ± 0.20 mg/kg/min for K + P; 0.40 ± 0.26 mg/kg/min for P-O; p < 0.0001), and might explain the shorter recovery time. Conclusion Both sedation approaches proved to be well tolerated and equally effective. Addition of ketamine was associated with reduction in the recovery time, probably explained by the statistically significant decrease in the propofol dose

The Use of DISC Behavioral Profiling and Training: An Innovative Pedagogical Strategy to Enhance Learning and Future Career Opportunities in Sport Management and Sport Coaching Higher Education Classrooms

Implementing effective training and education programs is of critical importance for sport management and sport coaching academic education programs. This exploratory ­­­­­research examined the implementation and effectiveness of DISC behavioral profiling in sport management and sport coaching classrooms at the university level. Over four academic years (eight semesters), pre- and post-tests were collected from multiple samples of sport management and sport coaching students (N = 216) at two universities in the United States. Students received a personalized DISC behavioral profile and educational activities were used to enhance the value of the behavioral profiling initiatives. Using pre- and post-activity surveys of the knowledge and skills gained during in-course activities, paired sample t-test showed positive and significant results for 11 of 16 measured areas. The findings suggest that behavioral profiling tools and activities within sport management and sport coaching curricula can enhance student’s self-awareness and help develop leadership skills which will prepare for future career opportunities. Limitations and opportunities for future research are also presented

Constrained Behavior: Understanding the Entrenchment of Legislative Procedure in American State Constitutional Law

Political analysts have suggested that policy power will begin to shift from the federal government to state governments as gridlock in Congress persists. Therefore, understanding the policymaking process at the state level is more important than ever. Vitally missing from our understanding of policymaking in the states is the role of constitutional provisions. Many state constitutions contain directives that severely limit the ability of the legislature to act. Some of these directives are procedural while others are more substantive. This is relevant because constitutional rules are more difficult for members to alter than chamber rules. In this paper we present a quantitative measure of constitutional restrictiveness and explore the variation in this measure across the fifty state legislatures and the U.S. Congress. We discover that constitutional restrictiveness is largely explained by the historical era in which the most recent constitution has been passed

Electoral Reforms, Membership Stability and the Existence of Committee Property Rights in American State Legislatures

One of the most creative theories advanced about legislative organization in recent years is Katz and Sala\u27s linkage of the development of committee property rights in the US House of Representatives to the introduction of the Australian ballot. Katz and Sala argue that the Australian ballot – a government-printed ballot cast in secret that replaced a party-produced ballot that was cast in public – gave members of the House an incentive to pursue personal constituency votes. This, in turn, led to the rise of committee property rights as members sought to keep their committee assignments from term to term because of the potential electoral benefits they derived from them. In this Note we use the state legislative committee membership dataset collected by Hamm and Hedlund and their colleagues to test whether committee property rights appeared in American state legislatures at roughly the same time as Katz and Sala find they emerged in the US House. State legislatures were, of course, exposed to the same electoral innovation at the same time. But, while in some ways state legislatures were much like Congress as organizations, in other ways they were very different. Our cross-sectional data and the variance in important institutional variables they provide allow us to test a critical proposition about the importance of membership stability rates in mediating the rise of committee property rights. We also go beyond Katz and Sala\u27s analysis by testing to see if differences in Australian ballot design (office column and party bloc) across the states influenced the behaviour of legislators in the way their theory suggests

Working in a Cage: The Evolution of Constitutional Restrictiveness in U.S. State Legislatures

The U.S. states have been characterized as “laboratories of democracy” for their ability to formulate public policies aimed at solving some of the most pressing public policy issues. The study of both public policy and legislative politics in the states has been quite robust. However, vitally missing from our understanding of policymaking and the legislative process in the states is the role of constitutional provisions. Many state constitutions contain directives that severely limit the ability of the legislature to act. Some of these directives are procedural while others are more substantive. This is relevant because constitutional rules are more difficult for members to alter than chamber rules and should lead us to question whether or not reform is needed. In previous research (Martorano Miller, Hamm and Hedlund 2009; 2010; 2011; 2014a; 2014b) we developed a quantitative measure of constitutional restrictiveness and explored current variation in this measure across the fifty state legislatures and the U.S. Congress. In this paper, we seek to expand upon our previous research by assessing provisions found in each state’s constitution in terms of the historical context surrounding the constitution’s adoption. We find that this “setting” has a significant impact on the constitutional provisions regarding the legislature’s powers restrictions and mandates. These features in turn create the “constraints” (a type of “cage”) limiting the legislature

The organisational and human resource challenges facing primary care trusts : protocol of a multiple case study

BACKGROUND: The study is designed to assess the organisational and human resource challenges faced by Primary Care Trusts (PCTs). Its objectives are to: specify the organisational and human resources challenges faced by PCTs in fulfilling the roles envisaged in government and local policy; examine how PCTs are addressing these challenges, in particular, to describe the organisational forms they have adopted, and the OD/HR strategies and initiatives they have planned or in place; assess how effective these structures, strategies and initiatives have been in enabling the PCTs to meet the organisational and human resources challenges they face; identify the factors, both internal to the PCT and in the wider health community, which have contributed to the success or failure of different structures, strategies and initiatives. METHODS: The study will be undertaken in three stages. In Stage 1 the key literature on public sector and NHS organisational development and human resources management will be reviewed, and discussions will be held with key researchers and policy makers working in this area. Stage 2 will focus on detailed case studies in six PCTs designed to examine the organisational and human resources challenges they face. Data will be collected using semi-structured interviews, group discussion, site visits, observation of key meetings and examination of local documentation. The findings from the case study PCTs will be cross checked with a Reference Group of up to 20 other PCG/Ts, and key officers working in organisational development or primary care at local, regional and national level. In Stage 3 analysis of findings from the preparatory work, the case studies and the feedback from the Reference Group will be used to identify practical lessons for PCTs, key messages for policy makers, and contributions to further theoretical development

Wolf movement patterns and the distribution of moose kills

Most studies regarding wolf (Canis lupus) predation on moose (Alces alces) have focused on the total annual consumption of moose within a wolf territory but few have tried to describe the spatial impact of wolf predation on a local scale. In this study I have analyzed wolf movement data, wolf predation, moose hunting statistics and moose hunter observations to investigate how wolf predation affects the human harvest of moose in Scandinavia. Since wolves prey on mostly juvenile moose during summer, analysis of their summer movement patterns is crucial to understand its impact on the human harvest later during autumn. In this study both reproducing (n = 45) and non-reproducing wolves (n = 12) reduced their movement range during summer to 66% and 67% of their annual movement range, respectively. Reproducing wolves increased their movement range from early to late summer while non reproducing wolves did not. There where also a difference regarding the average distance between each moose carcass and the calculated centre of mass for all kills found during each summer study. Non reproducing wolves had an average kill distribution of 14510 m (± 7111, n = 45) while reproducing wolves had a much more restricted kill distribution of 7923 m (± 4809, n = 96). Wolf presence within moose hunting license areas during summer where negatively correlated to the distance between the area and the wolf den. Either wolf presence within the moose hunting license areas during summer or the distance between the license areas and the wolf dens where correlated to the human hunting success during autumn, with one exception. The total human hunting success where reduced in license areas where wolves had spent more time during summer. The number of cows followed by twin calves observed by hunters was the only observation variable that where significantly negatively correlated with the distance to the wolf den. These results show that pup-rearing and denning behavior has an impact on the wolves hunting behavior during summer. It also shows that this central place foraging behavior during the reproductive season influences the local human hunting success only at a small scale. The human outtake of the moose population within the wolf territories was 3.8 ± 1.6 moose per 1000 hectares. In areas where moose densities are lower wolf predation may affect the local human harvest more negatively. The long term impact of wolf predation on the local scale may be higher if wolves choose to locate their den in the same area year after year

Neuronal cell replacement in Parkinson’s disease

Abstract. Hedlund E, Perlmann